Dagenham Eagles - Winter H.A.F. Booking Form

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Our Platinum Winter Extravaganza December 21-22, 2022 N.E.W.S.T.A.R.T. Activity offers seasonal hot food tasters, for children aged 5-12. Each day your child will engage in cooking and eating healthy meals on a low budget, develop resilience,physical stamina, life skills to include financial and mental wellbeing. Creative range of fun indoor/outdoor arts, crafts, using festive props, puppetry, fruit and vegetable mascots to effectively engage and develop individual confidence, respect, courage, leadership and responsibility in a safe and fun learning environment.

DISCLAIMER

COMPLETION OF THIS FORM DOES NOT CONFIRM A PLACE. WE WILL REVIEW DETAILS AND INDIVIDUAL PLACES WILL BE CONFIRMED VIA EMAIL OR TEXT IN DUE COURSE.

VENUE

Marks Gate Community Hub, Rose Lane, Romford RM6 5NJ

FIRST NAME *

SURNAME *

AGE OF CHILD *

ADDRESS (include street name and door number) *

POST CODE ( include FULL postal code )

ETHNICITY *

ABAN Asian or Asian British-Bangladeshi

APKN Asian or Asian British-Pakistani

BAFR Black or Black British-African

BOTH Black or Black British-Any Other Black

MWBC Mixed-White And Black Caribbean

MOTH Mixed-Any Other Mixed Background

OOTH Any Other Ethnic Group

WBRI White-British

WROM White-Gypsy/Roma

WOTH White-Any Other White Background

REFU Refused

Required

SCHOOL CHILD ATTENDING *

SCHOOL YEAR *

Does your child receive benefit-related free school meals or are they classed as vulnerable? Please note that this does not include the universal free school meals for all children in Reception - Year 2. *

YES. My child is a recipient of benefit-related free school meals/pupil premium

YES. My child is classed as vulnerable.

NO. My child is not eligible for the above and I am happy to pay £15.00/day or £25 for two days

Which statement best describes your child situation Select one statement only *

FSM non SEND Child who get FSM but don't have SEND

FSM SEND Child who get FSM and have SEND

Not FSM non SEND Child who don't get FSM, are otherwise vulnerable, but not SEND

Not FSM has SEND Child does not get FSM but do have SEND

Other Free Attendance funded by other sources ( evidence must be produced on registration)

Other Paid Child carer will pay daily on attendance for places

FSM benefit-related Child receives free school meals

SEND Child has special educational needs and/or disabilities

SELECT YOUR CHILD'S FUTURE ACTIVITY FUN CAMP *

Classical Music

Drumming

Lifestyle & Wellbeing

Outdoor Skills

Teen Leadership

Holiday Activity Food (HAF)

Music Theory

Music Exams

Other:

PARENT CONTACT DETAILS

PARENT FIRST NAME *

PARENT LAST NAME *

ADDRESS (please ensure to include name of the street, door number and name of maisonette, flats etc) *

Post Code ( Please ensure to include FULL home postal code is given, if different from child) *

EMAIL *

PHONE NUMBER *

EMERGENCY CONTACT FIRST NAME *

EMERGENCY CONTACT LAST NAME *

EMERGENCY CONTACT ADDRESS (IF DIFFERENT THAN ABOVE) *

EMERGENCY CONTACT EMAIL *

EMERGENCY CONTACT PHONE NUMBER *

DOES YOUR CHILD HAVE ANY SPECIAL NEEDS OR DISABILITIES? IF NO, TYPE "NONE". IF YES, EXPLAIN *

DOES YOUR CHILD HAVE ANY DIETARTY RESTRICTIONS OR REQUIREMENTS? IF NO, TYPE "NONE". IF YES, EXPLAIN *

DOES YOUR CHILD HAVE ANY ALLERGIES OR AILMENTS THAT WE SHOULD BE AWARE OF? IF NO, TYPE "NONE". IF YES, EXPLAIN *

PARENTAL CONSENT FOR TRAVEL, PHOTOGRAPHY & SOCIAL MEDIA

The programme will involve offsite and onsite travel to and from some of the activities and requires responsible photography for bite size social media footage to report visually HAF outcomes to the Department of Education, London Borough of Barking & Dagenham and other donors.

Q1. Do you give parental consent for your child to be responsibly photographed and the image used by our stakeholders and funders on their websites and social media for information, marketing and advertising? *

Yes

Q2. Do you give parental permission for your child to participate in travelling to and from off site activities? *

Yes

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